Homestead_Roberts (3)��•�•. CLAIM FOR HOMESTEAD PROPERTY TAX
d�P 4t CREDIT/STANDARD DEDUCTION
r�'c' . _ o
a : " 7 _
:� State Form 5473 (R2/1-90) � ��
�' '°�• � WSTRUCTIONS: See reverse side lor filing instructions.
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CERTIFICATION STATEMENT
FORM
HC10
� �05. - e1S �i.
� (We) �S�QJ(�Yr�A�v�J `-ii • �'' .�C��k ��V ) �rffi y that on the lsfday of March , 19 �
I( We) occup ed as our princip I place of residen�e the foilowing described real property for which a Homestead
Property Tax Credit is hereby claimed ❑ I(We) owned _ ❑ Are buying under contract
�Have a beneficial interest in ihe entity that is:liable for the property taxes on the property and that owns the
property or is buying it under a contracL
i • . .
CONTRACT RECORDED .
on contract. Fee Simple Owner's Name
Recorder's office where contract is recorded
nty
PROPERTY DESCRIPTION
1 - i Taxing District (City,
Parcel Number � I Legal Description V�� �_�� 1(' 3_�,a V • r0 �iG
Oo5 - ol o'j T �
If any portion of the resideniial structure or the land not exceeding one (1) acre that immediately surrounds that struc-
ture is used to produce income describe the use and.portion of the property utilized to produce income.
�� /���-�/. SI�% O�/
� PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIE
County Township County , � o
�
I hereby certify the above statements are true, correct and� S�ignature � �
�(Street, number. city, state and ZIP code) ' J �������
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ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Otherland
Tolal land - line (7 ) plus line (2)
Residential improvemen[s Dwelling
Garage
Other improvements
Total improvements - line (4) through line (6)
Total value - line (3) plus line (7)
I hereby certify the above is true,
correct, and complete
\/�.:�f�.inn Arfinn _ Cinnn}iiro nf 4�i(litnr
(�)
(2)
(3)
(4)
(5)
(6)
(�)
(8)
NON-RESIDENTIAL
VALUE
Date Signed
STANDARD DEDUCTION ALLOWANCE
1989 Pay 7990 1990 Pay 1991 1997 Pay 1992 79_ Pay 19—
Lesser of 1/2 Homestead Lesser of 1/2 Homestead Lesser of 7/2 Homestead Lesser of 7/2 Homestead
Valuation or $2,500 Valuation or $2,000 Valuation or $1,500 Valuation or $1,500
Signature of Auditor / � M� �
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Signed
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